A few years ago, anticipating changes in the wake of new federal requirements, several major players entered the Personal Health Record (PHR) arena, notably Google and Revolution Health (founded by Steve Case, co-founder of AOL). Well, today we learn the Revolution Health application is folding…while Google continues to grapple with public relations after media reports linking use of their application to medical errors.

These applications were targeted directly to patients, not health care providers. Patients are a.) entrenched in the current system, having never before been asked to maintain their own records, b.) not knowledgeable about medical data and how to interpret it, and c.) largely wary of technology. Those who aren’t wary may be cynical about the compatibility of PHR data between providers. It’s hardly surprising they’ve been slow to adopt, given the absence of institutional support.

So the initial ventures appear to be faltering…but don’t be deceived. We are hurtling towards a PHR-based records model. As more providers meet the national Electronic Health Record (EHR) conversion deadline, the PHR model will make the most logistical sense. It makes common sense as well. Think about it: Americans move on average every six years. They traverse a field littered with specialists and urgent care facilities. The only common denominator in the health history of a modern patient is the patient him/herself.

To wit, the Department of Health and Human Services (HHS) aggressively promotes PHRs among Medicare/Medicaid clients. Patient advocates have never stopped beating the drum. The question is not whether, but when and how PHRs will catch fire.

It might pay you to be ahead of the curve. As time and testing have repeatedly established: electronic records save money. A patient with a PHR costs $0 in administrative overhead. You won’t have to pay your staff to chase down hospital lab results or spend time on the phone with insurance companies. Plug it in, press a button and everything will be right in front of you. Press another button and send it to any other provider or pharmacy anywhere, instantly.

If that doesn’t sway you: the government is sweetening the deal. HHS will distribute billions of dollars this year in stimulus funding to health care providers who put EHR systems to what they call “meaningful use”. Last week the officer in charge of the program, Joshua Seidman, confirmed integrating PHRs into your system can help you qualify.

Steven Schiff, a California cardiologist, posted in favor of PHRs at the Huffington Post yesterday. A longtime user of EHR technology, he dispels a common concern about the future of progress notes…well worth a look.

For a more wonkish and thorough evaluation of the value of PHRs, you can download the Center for Information Technology Leadership (CiTL) PHR research report.

February 2010 is almost here, and implementation for the HITECH legislation is moving ahead on schedule. For those unaware, the HITECH Act is designed to promote the adoption of electronic health records (EHRs) by reimbursing physicians who purchase and use qualified EHR systems. Physicians with enough Medicare patients can receive up to $44,000, and physicians who see at least 30% Medicaid patients will qualify for $64,000. Meaningful Use is a set of standards physicians and EHR vendors must meet in order to qualify.

The Meaningful Use Interim Final Rule (IFR) and the Notice of Proposed Rulemaking (NPRM) is still within the public comment period, which lasts until March 15th. According to David Blumenthal, National Coordinator for Health Information Technology, the NPRM is “not a done deal.” The National Coordinator promises to entertain all comments “within the scope of the regulation.” The government won’t be able to add anything else to the rule, but may modify or remove existing aspects.

The Meaningful Use IFR will be much more difficult to change, according to Jodi Daniel, ONC’s director of the Office of Policy and Research. This is good because many EHR vendors are working to ensure their systems will meet the requirements. She said the office is still accepting comments, however, and expects some small changes.

Some groups view the meaningful use IFR requirements as “too high and too many.” Catholic Healthcare West, Intermountain Healthcare, and Kaiser Permanente have all adopted EHRs, but there are gaps between the systems’ features and meaningful use requirements. The groups are critical of the “all or nothing” approach taken by the legislation. In this case, the advantage lies with practices who do currently have an EHR system. They can purchase a system that will meet their needs and the meaningful use requirements right out of the box. Existing EHR users may face expensive upgrades.

Certification for meaningful use is also moving forward. CCHIT has discontinued their “preliminary” meaningful use certification and replaced it with an updated “meaningful use stage 1” comprehensive and modular certification. Although CCHIT has long been the most well-known certification agency, the National Institute of Standards and Technology (NIST) awarded consulting group Booz Allen Hamilton, Inc, a contract to develop a testing method and process for certifying EHRs. No one is sure which organization will actually issue certifications. According to Blumenthal, ONC will review the final legislation and see where CCHIT “fits in.” He states that CCHIT will “clearly have the option to participate in certification going forward,” but no one is sure exactly what that role will be.

Physicians need to get started with their EHR purchase post haste to qualify for the first year of reimbursements in 2011. Implementation of any EHR system usually takes a couple of months. In addition, many vendors are currently backlogged with installations. Contact your health IT consultant today to see how you can qualify.

The HITECH Stimulus Act is legislation designed to promote the adoption of Electronic Health Records (EHRs) among physicians. Passed near the beginning of 2009, the HITECH Act will reimburse qualified physicians who purchase and implement a certified EHR system. If a physician’s practice includes 30% Medicaid patients or more, they could qualify for up to $64,000. Medicare incentives could total up to $44,000, depending upon allowable charges.

“Meaningful Use” is a core concept of the HITECH Stimulus Act. Physicians must do more than simply seeing a certain amount of Medicaid or Medicare patients. “Meaningful Use” outlines a set of EHR features that physicians must use in their practice. On December 30th, 2009, The Centers for Medicare and Medicaid Services (CMS) along with the Office of the National Coordinator for Health Information Technology (ONC) published a final recommendation for the meaningful use definition.

Meaningful use is broken up into several stages. In Stage 1, physicians will have to use features like Computerized Physician Order Entry (CPOE), implement drug-to-drug, drug-to-allergy, and drug-to-forumlary checks, and maintain an updated problem list with ICD-9 or SNOMED, along with a whole host of other requirements. For the most part, the final recommendations look much the same as the initial recommendations from the ONC committee earlier in 2009. The final recommendations will take effect in approximately thirty days; the public is encouraged to comment for the next sixty days. CMS could decide to change the recommendations before final adoption, but most think any changes will be minor.

Deliberations over the meaningful use definitions created a great deal of uncertainty in the EHR market. Most physicians put their buying plans on hold, rather than taking the chance of purchasing an EHR that may not meet the requirements. While caution is understandable, physicians who wait too long may have trouble implementing an EHR in time to qualify for the 2011 reimbursements.

Purchasing an EHR is not like buying off-the-shelf software. With all the vendors, systems, and options, it normally takes several months to make a purchase decision. Once they sign papers, physicians may need to wait up to six months for installation to begin because of vendor backlogs. After installation, physicians and their staff still have to train, which can take weeks for more complicated systems.

Fortunately, the wait is over. CMS and ONC have published their final recommendations. EHR vendors are busy making sure their systems meet the meaningful use requirements. Likewise, physicians need to get busy with their EHR search. Physicians need to make a decision as soon as possible to qualify for 2011 and avoid increasing vendor backlogs. If you are interested in participating in the HITECH Stimulus, ask an EHR vendor to perform a needs analysis for your practice.

December is the time of year for gift-giving. Many of us are running around with our lists and packing our shopping carts full of DVDs, video games, holiday sweaters, and virtually everything imaginable for our loved ones. How many of those items will go back to be returned or exchanged the day after Christmas? Have you ever searched for the perfect gift that will always be useful, and never need to be returned, exchanged, or exiled to the back of a closet? This holiday season, consider purchasing an Electronic Health Record (EHR) system. EHRs will benefit you, your staff, and most importantly, your patients.

EHR systems benefit physicians in many ways. Before EHR, many of our physicians had to work late every night catching up on their documentation. Whether they were hand-writing charts, manually typing, or finishing up dictation, physicians can spend countless hours pushing papers. EHRs can eliminate paperwork and streamline your processes. You can use the extra time to focus on your patients, or leave the office early to spend with your family. Who wouldn’t want to spend more time with their loved ones around the holidays?

EHR systems can also help your office staff. Medical offices can be hectic places; your staff is probably bombarded with incoming phone calls and faxes, tracking down wayward charts, or helping patients that need to be checked in. EHR systems can reduce the fuss and give you a more relaxed work place. Digital faxing will eliminate constant inbound paper faxes, along with the need to manually file faxed paper work. Electronic charts can drastically reduce the time it takes to locate a patient’s files. Up to 60% of the charts your staff pulls daily could be from pharmacy or patient phone calls. EHR systems can cure your headaches and let your staff focus on your patients.

Finally, EHR systems can give the greatest gift to your patients, the gift of improved care. Electronic prescribing ensures that your prescriptions are filled accurately. There is no chance of a pharmacists misreading a script and potentially endangering your patients. Drug-drug and drug-allergy checks can prevent dangerous medication interactions from harming your patients. Formulary checks will ensure your patients get medications their insurance will cover. Order management can remind your patients to follow up on any labs or procedures you order for them. Patient portals and Personal Health Records allow your patient to become more involved in the healthcare process, giving them access to their health information.

If you are thinking about EHR, consider the reasons to purchase one this December. First, tax code 179 allows your practice to write off technology expenses up to $225,000 for systems purchased during 2009. Second, the HITECH Stimulus Act allocates federal money to reimburse physicians for purchasing and implementing a certified EHR. Third, purchasing in December will allow you to hit the ground running in January, so you, your staff, and your patients can start reaping the benefits of EHR. This holiday system, give the gift that keeps on giving. Give the gift of EHR.

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides reimbursements to physicians who purchase and implement an Electronic Health Record (EHR). In order to participate in the program, physicians and EHR vendors must meet a set of requirements. You may have heard the term “meaningful use” in the news; it refers to a set of requirements for physicians and vendors. EHR vendors must provide certain functionality, and physicians must actually utilize the features in their practice.

Interoperability between different EHR systems is one of the main goals of meaningful use. Sharing patient data has many benefits, such as aiding clinical research, ensuring medical information is available as patients change providers, and adding to a knowledgebase which can help doctors with diagnostic and treatment issues. However, before EHR systems can share data, they must all speak the same language. Here is a brief look at some of the data standards proposed for inclusion in meaningful use:

SNOMED CT – Systematized Nomenclature of Medicine – Clinical Terms is a standardized medical vocabulary pertaining to most areas of clinical information. It offers a consistent way to access and store information across different specialties and practices. Meaningful use requires SNOMED for clinical problems and procedures.

LOINC – Logical Observation Identifiers Names and Codes – is the proposed meaningful use data standard used for identifying and recording laboratory observations and results.

RxNorm – is a standardized nomenclature for clinical drugs and delivery devices, and is the proposed standard for drug and medication allergies.

UCUM – The Unified Code for Units of Measure is a code system that includes all units of measure currently used in science, engineering, and business. It is designed to facilitate electronic communication and is proposed for meaningful use.

UNII – Unique Ingredient Identifier is an FDA standard designed to create a universal way to identify different ingredients found in drugs, biologics, food, and devices. Meaningful use will require UNII for tracking allergens.

Although these standards may seem arcane to physicians, they could determine whether or not a practice qualifies for the HITECH stimulus reimbursements. If you currently have an EHR, check with your vendor to see if they support these standards. If you have not yet purchased an EHR, be sure to ask the vendor if they support these standards. Remember, qualified professionals can receive $66,000 under Medicaid, and up to $44,000 under Medicare. The reimbursements start in 2011, so physicians should purchase an EHR soon to qualify in time.